Heterogeneous neuroimaging findings across substance use disorders localize to a common brain network

Substance use disorders are associated with neuroimaging abnormalities, but results are heterogeneous across studies and vary across substances, and the causal interpretation of these abnormalities is unknown. We have used network mapping approaches and a functional connectome from a large cohort of healthy participants (n = 1,000) to test whether neuroimaging abnormalities across substance use disorders map to a common brain network. Starting with coordinates of regional brain atrophy from 45 studies (3,791 participants), we found that 91% of the neuroimaging findings mapped to a common brain network. This network was specific to substance use disorder compared to atrophy associated with normal aging and neurodegenerative disease (P-FWE < 0.05). Coordinates of functional MRI abnormalities from 99 studies (5,256 participants) mapped to a similar brain network. We found no differences in networks across different substance use categories. We combined all substance use disorder data (144 studies, 9,047 participants) to generate an overall coordinate-based network for substance use disorder, which included positive connectivity to the anterior cingulate, bilateral insulae, dorsolateral prefrontal cortices and thalamus, and negative connectivity to the medial prefrontal and occipital cortices. Lesions resulting in remission from nicotine use disorder (n = 34) intersected this network significantly more than control lesions (n = 69; P < 0.0084). We conclude that neuroimaging abnormalities across substance use disorders map to a common brain network that is similar across imaging modalities, substances and lesion locations that cause remission from substance use disorders.